Diagnostic Performances of 18F-FDG Positron Emission Tomography in Large Vessels Vasculitis: Meta-analysis

Toperform a meta-analysis of FDG-PET performances in the diagnosis of largevessels vasculitis (Giant Cell Arteritis (GCA) associated or not withPolymyalgia Rheumatica(PMR), Takayasu). Materials and methods : The MEDLINE,Cochrane Library, Embase were searched for relevant original articlesdescribing FDG-PET for vasculitis assessment, using MesH terms ("GiantCell Arteritis or Vasculitis" AND "PET"). Criteria for inclusionwere:(1)FDG-PET for diagnosis of vasculitis(2)American College of Rheumatologycriteria as reference standard(3)control group. After data extraction, analyseswere performed using a random-effects model. Results : Of 184 citations(database search and references screening),70 articles were reviewed of which12 eligible studies were extracted (sensitivity range from 32% to 97%). 7studies fulfilled all inclusion criteria. Owing to overlapping population, 1study was excluded. Statistical heterogeneity justified the random-effectsmodel. Pooled 6 studies analysis(116 vasculitis,224 controls) showed a 81%sensitivity (95%CI:70-89%);a 89% specificity (95%CI:77-95%);a 85%PPV(95%CI:63-95%); a 90% NPV(95%CI:79-95%);a 7.1 positive LR(95%CI:3.4-14.9); a0.2 negative LR(95%CI:0.14-0.35) and 90.1 DOR(95%CI: 18.6-437). Conclusion :FDG-PET has good diagnostic performances in the detection of large vesselsvasculitis. Its promising role could be extended to follow up patients undertreatment, but further studies are needed to confirm this possibility.

Selecting statistical models to study the relationship between soybean yield and soil physical properties

Statistical models allow the representation of data sets and the estimation and/or prediction of the behavior of a given variable through its interaction with the other variables involved in a phenomenon. Among other different statistical models, are the autoregressive state-space models (ARSS) and the linear regression models (LR), which allow the quantification of the relationships among soil-plant-atmosphere system variables. To compare the quality of the ARSS and LR models for the modeling of the relationships between soybean yield and soil physical properties, Akaike's Information Criterion, which provides a coefficient for the selection of the best model, was used in this study. The data sets were sampled in a Rhodic Acrudox soil, along a spatial transect with 84 points spaced 3 m apart. At each sampling point, soybean samples were collected for yield quantification. At the same site, soil penetration resistance was also measured and soil samples were collected to measure soil bulk density in the 0-0.10 m and 0.10-0.20 m layers. Results showed autocorrelation and a cross correlation structure of soybean yield and soil penetration resistance data. Soil bulk density data, however, were only autocorrelated in the 0-0.10 m layer and not cross correlated with soybean yield. The results showed the higher efficiency of the autoregressive space-state models in relation to the equivalent simple and multiple linear regression models using Akaike's Information Criterion. The resulting values were comparatively lower than the values obtained by the regression models, for all combinations of explanatory variables.

Autocrine secretion of IGF2 regulates adult ß cell functional plasticity

In the pathogenesis of type 2 diabetes, hyperglycemia appears when ß cell mass and insulin secretory capacity are no longer sufficient to compensate for insulin resistance. The reduction in ß cell mass results from increased apoptosis. Therefore, finding strategies to preserve ß cell mass and function may be useful for the treatment or prevention of diabetes. Glucagon-like peptide-1 (GLP-1) protects ß cells against apoptosis, increases their glucose competence, and induces their proliferation. Previous studies in the lab of Prof. Bernard Thorens showed that the GLP-1 anti- apoptotic effect was mediated by robust up-regulation of IGF-1R expression, and this was paralleled with an increase in Akt phosphorylation. This effect was dependent not only on increased IGF-1R expression but also on the autocrine secretion of insulin-like growth factor 2 (IGF2). They also demonstrated that GLP-1 up-regulated IGF-1R expression by a protein a kinase A-dependent translational control mechanism. The main aim of this PhD work has been to further investigate the role of the IGF2/IGF-1 Receptor autocrine loop in ß cell function and to determine the physiological role of IGF2 in ß cell plasticity and its regulation by nutrients. This PhD thesis is divided in 3 chapters. The first chapter describes the role of IGF2/IGF-1R autocrine loop in ß cell glucose competence and proliferation. Here using MIN6 cells and primary mouse islets as an experimental model we demonstrated that the glucose competence of these cells was dependent on the level of IGF-1R expression and on IGF2 secretion. Furthermore, we showed that GLP-1-induced primary ß cell proliferation was significantly reduced by Igf-lr gene inactivation and by IGF2 immunoneutralization or knockdown. In the second chapter we examined the role of this IGF2/IGF-1R autocrine loop on the ß cell functional plasticity during ageing, pregnancy, and in response to acute induction of insulin resistance using mice with ß cell-specific inactivation of ig/2. Here we showed a gender-dependent role of ß cell IGF2 in ageing and high fat diet-induced metabolic stress; we demonstrated that the autocrine secretion of IGF2 is essential for ß cell mass adaptation during pregnancy. Further we also showed that this autocrine loop plays an important role in ß cell expansion in response to acute induction of insulin resistance. The aim of the third chapter was to investigate whether we can modulate the expression and secretion of IGF2 by nutrients in order to increase the activity of autocrine loop. Here we showed that glutamine induces IGF2 biosynthesis and its fast secretion through the regulated pathway, a mechanism enhanced in the presence of glucose. Furthermore, we demonstrated that glutamine-mediated Akt phosphorylation is dependent on IGF2 secretion, indicating that glutamine controls the activity of the IGF2/IGF1R autocrine loop through IGF2 up-regulation. In summary, this PhD work highlights that autocrine secretion of IGF2 is required for compensatory ß cell adaptation to ageing, pregnancy, and insulin resistance. Moreover IGF2/IGF1R autocrine loop is regulated by two feeding-related cues, GLP-1 to increase IGF-1R expression and glutamine to control IGF2 biosynthesis and secretion. -- Dans le diabète de type 2, lorsque la sécrétion d'insuline des cellules Beta du pancréas n'est plus suffisante pour compenser la résistance à l'insuline, une hyperglycémie est observée. Cette baisse de sécrétion d'insuline est Causée par la diminution de la masse de cellules Beta suite à l'augmentation du phénomène de mort cellulaire ou « apoptose ». En diabétologie, une des stratégies médicales concerne la préservation des cellules Beta du pancréas. Une des protéines intervenant dans cette fonction est GLP-1 (Glucagon-like peptide-1). GLP-1 est capable de protéger les cellules Beta contre la mort cellulaire et d'induire leur prolifération. Des études précédemment menées dans le laboratoire du Professeur Bernard Thorens ont montrées que l'activité « anti-apoptotique » de GLP-1 est le résultat l'une augmentation de l'expression du gène IGF-1R sous la dépendance de la sécrétion autocrine d'IGF2 (Insulin-Like Growth Factor). Le but de mon travail de thèse aura été d'étudier le mécanisme de la régulation de GLP-1 par IGF2 et plus précisément de déterminer le rôle physiologique d'IGF2 dans la plasticité des cellules ß ainsi que sa régulation par les nutriments. Ce manuscrit est ainsi divisé en trois chapitres : Le premier chapitre décrit la fonction d'IGF2/IGF- R1 dans la réponse des cellules Beta au glucose ainsi que dans leur capacité à proliférer. Dans ce chapitre nous avons montré l'importance du niveau d'expression d'IGFR-1 et de la sécrétion d'IGF2 dans la régulation du métabolisme du glucose. Dans un deuxième chapitre, nous étudions la boucle de régulation IGF2/IGF-R1 sur la plasticité des cellules Beta lors du vieillissement, de la grossesse ainsi que dans un modèle de souris résistantes à l'insuline. Cette étude met en évidence un dimorphisme sexuel dans le rôle d'IGF2 lors du vieillissement et lors d'un stress métabolique. Nous montrons également l'importance d'IGF2 pour l'adaptation des cellules Beta tout au long de la grossesse ou lors du phénomène de résistance à l'insuline. Dans un troisième chapitre, nous mettons en évidence la possibilité de moduler l'expression et la sécrétion d'IGF2 par les nutriments. En conclusion, ce travail de thèse aura permis de mettre en évidence l'importance d'IGF2 dans la plasticité des cellules ß, une plasticité indispensable lors du vieillissement, de la grossesse ou encore dans le cas d'une résistance à l'insuline.

Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography in the assessment of pleural abnormalities in cancer patients: A systematic review and a meta-analysis.

OBJECTIVE: To systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the assessment of pleural abnormalities in cancer patients. METHODS: A comprehensive literature search of studies published through June 2013 regarding the role of (18)F-FDG-PET and PET/CT in evaluating pleural abnormalities in cancer patients was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odd ratio (DOR) of (18)F-FDG-PET or PET/CT on a per patient-based analysis were calculated. The area under the summary ROC curve (AUC) was calculated to measure the accuracy of these methods in the assessment of pleural abnormalities. Sub-analyses considering (18)F-FDG-PET/CT and patients with lung cancer only were carried out. RESULTS: Eight studies comprising 360 cancer patients (323 with lung cancer) were included. The meta-analysis of these selected studies provided the following results: sensitivity 86% [95% confidence interval (95%CI): 80-91%], specificity 80% [95%CI: 73-85%], LR+ 3.7 [95%CI: 2.8-4.9], LR- 0.18 [95%CI: 0.09-0.34], DOR 27 [95%CI: 13-56]. The AUC was 0.907. No significant improvement considering PET/CT studies only and patients with lung cancer was found. CONCLUSIONS: (18)F-FDG-PET and PET/CT demonstrated to be useful diagnostic imaging methods in the assessment of pleural abnormalities in cancer patients, nevertheless possible sources of false-negative and false-positive results should be kept in mind. The literature focusing on the use of (18)F-FDG-PET and PET/CT in this setting remains still limited and prospective studies are needed.

Atributos físicos de Cambissolo Háplico em vinhedos submetidos a intensidades de tráfego

Em vinhedos, o tráfego de máquinas agrícolas causa compactação do solo que pode ser mais acentuada nas entrelinhas pela maior intensidade de tráfego. Este trabalho objetivou avaliar a variabilidade dos atributos físicos do solo em razão da posição de amostragem em relação à linha de plantio, em vinhedos comerciais da variedade Bordô em pé franco, submetidos a diferentes manejos da cultura. Em fevereiro de 2012, três vinhedos foram selecionados no município de Major Gercino (SC), sendo um manejado sem a utilização de máquinas agrícolas (vinhedo 1: com seis anos de implantação) e dois que utilizam máquinas nas entrelinhas (vinhedos 2 e 3: com oito e 17 anos, respectivamente). Na linha de plantio (Lp), na linha do rodado (Lr) e entre a linha de plantio e a linha do rodado (El), foram coletadas amostras indeformadas de solo nas camadas de 0,00-0,05, 0,05-0,10, 0,10-0,15 e 0,15-0,20 m de profundidade. Avaliaram-se a densidade do solo (Ds), a resistência à penetração (Rp), as classes de poros (macroporos - MaP, mesoporos - MeP, microporos - MiP e porosidade total - PT), os índices de agregação e de estabilidade de agregados (Diâmetro médio geométrico dos agregados secos ao ar e estáveis em água - DMGsa e DMGea, índice de estabilidade de agregados - IEA), a umidade gravimétrica (Ug), a densidade das partículas e a granulometria do solo. O estado de compactação aumentou no sentido da Lp para a Lr. A ocorrência de tráfego, em geral, influenciou negativamente os atributos avaliados. Entre as posições de amostragem, os maiores valores de Ds e Rp ocorreram na Lr, em que a Rp atingiu valores críticos ao desenvolvimento de raízes; nos vinhedos mecanizados, foram encontrados elevados valores de Rp e baixos de MaP nas camadas de 0,00-0,05 e 0,05-0,10 m. Observaram-se agregados com maior diâmetro e menores IEA, o que indica deterioração da qualidade física do solo. No vinhedo 1, houve menor variabilidade dos atributos físicos, enquanto no vinhedo 2 verificou-se influência negativa do tráfego de máquinas, principalmente para os atributos relacionados à agregação e elevada MiP. No vinhedo 3, observaram-se os maiores índices de Rp e de Ds, bem como o menor valor de MaP. Portanto, em relação aos vinhedos estudados, verificou-se aumento da degradação física do solo proporcionado pelo tráfego de máquinas (vinhedos 2 e 3). Dentre as posições de coletas e os vinhedos, evidenciou-se, por meio da análise de componentes principais, a separação da posição Lr do vinhedo 3, em razão dos atributos Ds e Rp, permitindo inferir que o manejo adotado na posição Lr está ocasionando maior degradação da qualidade física do solo.

Does this child have a foreign body aspiration?

Context: Foreign body aspiration (FbA) is a serious problem in children. Accurate clinical and radiographic diagnosis is important because missed or delayed diagnosis can result in respiratory difficulties ranging from life-treatening airway obstruction to chronic wheezing or recurrent pneumonia. Bronchoscopy also has risks and accurate clinical and radiographc diagnosis can support the decision of bronchoscopy. Objective: To rewiev the diagnostic accuracy of clinical presentation (CP) and pulmonary radiograph (PR) for the diagnosis of FbA. There is no previous rewievMethods: A search of Medline is conducted for articles containing data regarding CP and PR signes of FbA. Calculation of likelihood ratios (LR) and pre and post test probability using Bayes theorem were performed for all signs of CP and PR. Inclusion criteria: Articles containing prospective data regarding CP and PR of FbA. Exclusion criteria: Retrospectives studies. Articles containing incomplete data for calculation of LR. Results: Five prospectives studies are included with a total of 585 patients. Prevalence of FbA is 63% in children suspected of FbA. If CP is normal, probability of FbA is 25% and if PR is normal, probability is 14%. If CP is pathologic, probability of FbA is 69-76% with presence of cough (LR = 1.32) or dyspnea (LR = 1.84) or localized crackles (LR = 1.5). Probability is 81-88% if cyanosis (LR = 4.8) or decreased breaths sounds (LR = 4.3) or asymetric auscultation (LR = 2.9) or localized wheezing (LR = 2.5) are present. When CP is anormal and PR show mediatinal shift (LR = 100), pneumomediatin (LR = 100), radio opaque foreign body (LR = 100), lobar distention (LR = 4), atelectasis (LR = 2.5), inspiratory/expiratory abnormal (LR = 7), the probability of FbA is 96-100%. If CP is normal and PR is abnormal the probability is 40-100%. If CP is abnormal and PR is normal the probability is 55-75%. Conclusions: This rewiev of prospective studies demonstrates the importance of CP and PR and an algorithm can be proposed. When CP is abnormal with or without PR pathologic, the probability of FbA is high and bronchoscopy is indicated. When CP and PR are normal the probability of FbA is low and bronchoscopy is not necessary immediatly, observation should be proposed. This approach should be validated with prospective study.

Evidential relevance in scene to offender transfer cases: development and analysis of a likelihood ratio for offence level propositions

The present paper focuses on the analysis and discussion of a likelihood ratio (LR) development for propositions at a hierarchical level known in the context as 'offence level'. Existing literature on the topic has considered LR developments for so-called offender to scene transfer cases. These settings involve-in their simplest form-a single stain found on a crime scene, but with possible uncertainty about the degree to which that stain is relevant (i.e. that it has been left by the offender). Extensions to multiple stains or multiple offenders have also been reported. The purpose of this paper is to discuss a development of a LR for offence level propositions when case settings involve potential transfer in the opposite direction, i.e. victim/scene to offender transfer. This setting has previously not yet been considered. The rationale behind the proposed LR is illustrated through graphical probability models (i.e. Bayesian networks). The role of various uncertain parameters is investigated through sensitivity analyses as well as simulations.

Catàleg de plantes vasculars endèmiques, rares o amenaçades de Catalunya. I. Tàxons endèmics

Catalogue of endemic, rare or threatened vascular plants in Catalonia. I. Endemic taxa. This is the first of a set of papers devoted to rare or threatened plants in Catalonia. We list 279 specific or subspecific taxa which are in a broad sense endemic to the northeastern part of the Iberian Peninsula. We assess them with regard to their conservation status according to IUCN criteria. Assignment of these taxa to established categories has led to the following results: 6 taxa critically endangered (CR), 5 endangered (EN), 32 vulnerable (VU), 5 near threatened (LR nt). 84 least concern (LR lc), 116 not threatened (NT) and 31 data deficient (DD). The small number of taxa that enjoy legal protection in comparison with the number of threatened plants is emphasized. Key words: Endemic plants, Catalonia, Plant conservation, UICN categories.

Common variants near MC4R are associated with fat mass, weight and risk of obesity.

To identify common variants influencing body mass index (BMI), we analyzed genome-wide association data from 16,876 individuals of European descent. After previously reported variants in FTO, the strongest association signal (rs17782313, P = 2.9 x 10(-6)) mapped 188 kb downstream of MC4R (melanocortin-4 receptor), mutations of which are the leading cause of monogenic severe childhood-onset obesity. We confirmed the BMI association in 60,352 adults (per-allele effect = 0.05 Z-score units; P = 2.8 x 10(-15)) and 5,988 children aged 7-11 (0.13 Z-score units; P = 1.5 x 10(-8)). In case-control analyses (n = 10,583), the odds for severe childhood obesity reached 1.30 (P = 8.0 x 10(-11)). Furthermore, we observed overtransmission of the risk allele to obese offspring in 660 families (P (pedigree disequilibrium test average; PDT-avg) = 2.4 x 10(-4)). The SNP location and patterns of phenotypic associations are consistent with effects mediated through altered MC4R function. Our findings establish that common variants near MC4R influence fat mass, weight and obesity risk at the population level and reinforce the need for large-scale data integration to identify variants influencing continuous biomedical traits.

Comparação entre métodos para o estudo da estabilidade de agregados em solos

A estabilidade de agregados constitui-se em importante parâmetro na avaliação do efeito de manejo na agregação de solos. Entretanto, os resultados obtidos pelos diferentes métodos são, às vezes, contrastantes, e alguns desses métodos não permitem a definição do nível de energia envolvido na análise. Objetivou-se, com este estudo, comparar diferentes métodos para determinação da estabilidade de agregados em solos. Agregados de horizontes A e B de Latossolo Roxo (LR) e Terra Roxa Estruturada (TR) foram submetidos a peneiramento úmido, três testes de impacto de gotas, e sonificação a oito níveis de energia ultra-sônica; o primeiro foi comparado aos últimos, que permitem a quantificação da energia aplicada. De modo geral, o LR apresentou agregados mais estáveis do que a TR; a resistência dos agregados a altos níveis de energia ultra-sônica foi relacionada a teores de matéria orgânica, óxidos de ferro e gibbsita. Os resultados de diâmetro médio ponderado e porcentagem de agregados maiores que 2 mm foram semelhantes nos horizontes A de ambos os solos. O impacto de gotas causou maior desagregação no material de horizonte B do LR, enquanto o material de horizonte B da TR foi mais afetado pelo peneiramento úmido. O nível de 15,88 J mL-1 se apresentou, na sonificação, como mais sensível para detectar diferenças entre solos estudados.

Avaliação espectral de solos desenvolvidos em uma toposseqüência de diabásio e folhelho da região de Piracicaba, SP

Este trabalho teve como objetivo estudar as alterações de solosdesenvolvidos numa toposseqüência composta por diabásio e folhelho (Piracicaba, SP), e sua relação com os dados espectrais. Ocorrem na toposseqüência os solos Latossolo Roxo (LR), Latossolo Vermelho-Escuro (LE), Podzólico Vermelho-Escuro (PE), Litossolo (Li) e Aluvial (Al) dos quais foram coletadas amostras a três profundidades. Foram obtidos dados de reflectância bidirecional dessas amostras em laboratório com espectrorradiômetro na faixa de 350 a 2.500 nm. As alterações da reflectância das amostras de solo das camadas superficiais e subsuperficiais foram relacionadas às diferenças nos teores de matéria orgânica e argila, que foram parâmetros importantes na caracterização espectral dos solos. Ao longo da toposseqüência, ocorreram alterações nas características dos solos, principalmente nos teores de ferro e silte e na mineralogia, que influenciaram nos dados espectrais. Os solos desenvolvidos de diabásio apresentaram altos teores de ferro, o que refletiu em concavidades mais acentuadas nas curvas espectrais em 850 nm, e intensidades de reflectância menores, ao contrário dos solos desenvolvidos de folhelho. A reflectância do PE apresentou-se mais intensa do que o LR e LE. Os solos menos intemperizados Li e Al apresentaram intensidades de reflectância mais elevadas que os mais intemperizados, LR e LE.

Characterization and discrimination of soils by their reflected electromagnetic energy

The objective of this work was to verify if reflected energy of soils can characterize and discriminate them. A spectroradiometer (Spectral reflectance between: 400-2,500 nm) was utilized in laboratory. The soils evaluated are located in Bauru region, SP, Brazil, and are classified as Typic Argiudoll (TR), Typic Eutrorthox (LR), Typic Argiudoll (PE), Typic Haplortox (LE), Typic Paleudalf (PV) and Typic Quartzipsamment (AQ). They were characterized by their spectral reflectance as for descriptive conventional methods (Brazilian and International) according to the types of spectral curves. A method for the spectral descriptive evaluation of soils was established. It was possible to characterize and discriminate the soils by their spectral reflectance, with exception for LR and TR. The spectral differences were better identified by the general shape of spectral curves, by the intensity of band absorption and angle tendencies. These characteristics were mainly influenced by organic matter, iron, granulometry and mineralogy constituents. A reduction of iron and clay contents, which influenced higher reflectance intensity and shape variations, occurred on the soils LR/TR, PE, LE, PV and AQ, on that sequence. Soils of the same group with different clay textures could be discriminated. The conventional descriptive evaluation of spectral curves was less efficient on discriminating soils. Simulated orbital data discriminated soils mainly by bands 5 and 7.

Different likelihood ratio approaches to evaluate the strength of evidence of MDMA tablet comparisons

Two likelihood ratio (LR) approaches are presented to evaluate the strength of evidence of MDMA tablet comparisons. The first one is based on a more 'traditional' comparison of MDMA tablets by using distance measures (e.g., Pearson correlation distance or a Euclidean distance). In this approach, LRs are calculated using the distribution of distances between tablets of the same-batch and that of different-batches. The second approach is based on methods used in some other fields of forensic comparison. Here LRs are calculated based on the distribution of values of MDMA tablet characteristics within a specific batch and from all batches. The data used in this paper must be seen as examples to illustrate both methods. In future research the methods can be applied to other and more complex data. In this paper, the methods and their results are discussed, considering their performance in evidence evaluation and several practical aspects. With respect to evidence in favor of the correct hypothesis, the second method proved to be better than the first one. It is shown that the LRs in same-batch comparisons are generally higher compared to the first method and the LRs in different-batch comparisons are generally lower. On the other hand, for operational purposes (where quick information is needed), the first method may be preferred, because it is less time consuming. With this method a model has to be estimated only once in a while, which means that only a few measurements have to be done, while with the second method more measurements are needed because each time a new model has to be estimated.

Troponin-based risk stratification of patients with acute nonmassive pulmonary embolism: systematic review and metaanalysis.

BACKGROUND: Controversy exists regarding the usefulness of troponin testing for the risk stratification of patients with acute pulmonary embolism (PE). We conducted an updated systematic review and a metaanalysis of troponin-based risk stratification of normotensive patients with acute symptomatic PE. The sources of our data were publications listed in Medline and Embase from 1980 through April 2008 and a review of cited references in those publications. METHODS: We included all studies that estimated the relation between troponin levels and the incidence of all-cause mortality in normotensive patients with acute symptomatic PE. Two reviewers independently abstracted data and assessed study quality. From the literature search, 596 publications were screened. Nine studies that consisted of 1,366 normotensive patients with acute symptomatic PE were deemed eligible. Pooled results showed that elevated troponin levels were associated with a 4.26-fold increased odds of overall mortality (95% CI, 2.13 to 8.50; heterogeneity chi(2) = 12.64; degrees of freedom = 8; p = 0.125). Summary receiver operating characteristic curve analysis showed a relationship between the sensitivity and specificity of troponin levels to predict overall mortality (Spearman rank correlation coefficient = 0.68; p = 0.046). Pooled likelihood ratios (LRs) were not extreme (negative LR, 0.59 [95% CI, 0.39 to 0.88]; positive LR, 2.26 [95% CI, 1.66 to 3.07]). The Begg rank correlation method did not detect evidence of publication bias. CONCLUSIONS: The results of this metaanalysis indicate that elevated troponin levels do not adequately discern normotensive patients with acute symptomatic PE who are at high risk for death from those who are at low risk for death.

09006-003 Bear Creek Watershed Final Report

Bear Creek is an impaired warm water fishery designated as class B(LR) by the Iowa DNR and is on 303 impaired waters list for fish kills and ammonia. Bear Creek is located in eastern Delaware County. This project is designed to improve the water quality of Bear Creek by educating the landowners, operators and watershed community about the importance of this water resource. The goal of the Bear Creek Watershed Project is to improve the water quality of Bear Creek by reducing the amounts of ammoniated manure discharge, fecal coliform bacteria, sediment, nitrogen, and phosphorous. The Bear Creek Watershed Project has been a watershed project since July 2004, first as a Demo project FY 2004-2005 and then full time WSPF/319 project FY06-09. Fish kills have not occurred in 2008-2009. Sediment delivery has decreased in the Bear Creek Watershed by 5,328 tons per year. The objectives of this watershed project will be to improve Livestock Waste Storage, to improve Livestock Waste Usage, to decrease Sediment Losses, and to improve Education & Area Outreach. This project will install 2 manure storage structures (EQIP/project funded), 19 ac of CRP waterways, 12 ac of project waterways, 17 ac of CRP filter strips along stream, 12 water and sediment control basins, 18,000 ft of terraces, 350 ac of new notill planting, and 3,700 ft of streambank protection.